Provider Demographics
NPI:1437635232
Name:MECLGARTLAND, MICHAELA (LVN, RN)
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:
Last Name:MECLGARTLAND
Suffix:
Gender:F
Credentials:LVN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 24TH ST APT 109
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2453
Mailing Address - Country:US
Mailing Address - Phone:510-563-9037
Mailing Address - Fax:
Practice Address - Street 1:1313 CUTTING BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2554
Practice Address - Country:US
Practice Address - Phone:510-232-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95179113163WC1500X
CA282611164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health